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Biomedical subjects

Todd H Baron

Publications and source records attributed to Todd H Baron.

At least 127 records · Page 7Linked to original sources
PubMed2002

Safety and outcome of endoscopic snare excision of the major duodenal papilla.

BACKGROUND: The optimal management of adenoma of the major duodenal papilla is not established. Options include surgical excision, endoscopic ablative techniques, snare excision, and observation with periodic biopsies. The aims of this retrospective study were to determine the safety and outcome of snare excision of the papilla. METHODS: Twenty-eight snare excisions of the papilla were performed in 26 patients. Sixteen had familial adenomatous polyposis. In 22 procedures, a minisnare was used, and in 6 cases a prototype snare was designed for excision of the papilla. Pancreatic stents were placed as a prophylactic measure at the discretion of the endoscopist (n = 10). RESULTS: Histopathologically, resected tissue included 25 adenomas, 1 inflammatory polyp, 1 invasive malignancy, and 1 normal papilla. Immediate complications were minor bleeding (n = 2), mild pancreatitis (n = 4) and a duodenal perforation (n = 1). The presence (n = 10) or absence (n = 18) of a pancreatic stent did not correlate with subsequent pancreatitis (2 in each group, p = NS). Follow-up was available for 21 patients (median, 9 months; range, 2-32 months). Pancreatic duct stenosis at the papillectomy site resulted in pancreatitis in 2 patients (17%) at, respectively, 4 months and 24 months. Follow-up endoscopy revealed recurrent/residual adenomatous tissue in 2 (10%). CONCLUSIONS: Snare excision of the major duodenal papilla was well tolerated. Most complications were mild except for a small duodenal perforation. Stenosis of the pancreatic duct orifice with pancreatitis may be a late complication.

Adenomatous Polyposis Coli↗
PubMed2002

Guideline on the management of anticoagulation and antiplatelet therapy for endoscopic procedures.

This is one of a series of statements discussing the practice of gastrointestinal endoscopy in common clinical situations. It is intended to aid endoscopists in determining the appropriate use of endoscopic procedures in conjunction with anticoagulation and/or antiplatelet therapy. Guidelines for the appropriate practice of endoscopy are based on critical review of the available data and expert consensus. Controlled clinical studies would be beneficial to clarify some aspects of this statement and revision might be necessary as new data appear. Clinical consideration may justify a course of action at variance from these specific recommendations.

Anticoagulants↗
PubMed2002

Methods of granting hospital privileges to perform gastrointestinal endoscopy.

This is one of a series of statements discussing the utilization of gastrointestinal endoscopy in common clinical situations. The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy prepared this text. In preparing this guideline, a MEDLINE literature search was performed, and additional references were obtained from the bibliographies of the identified articles and from recommendations of expert consultants. When little or no data exist from well-designed prospective trials, emphasis is given to results from large series and reports from recognized experts. Guidelines for appropriate utilization of endoscopy are based on a critical review of the available data and expert consensus. Further controlled clinical studies are needed to clarify aspects of this statement, and revision may be necessary as new data appear. Clinical consideration may justify a course of action at variance to these recommendations.

Credentialing↗
PubMed2002

Complications of upper GI endoscopy.

This is one of a series of statements discussing the utilization of gastrointestinal endoscopy in common clinical situations. The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy prepared this text. In preparing this guideline, a MEDLINE literature search was performed, and additional references were obtained from the bibliographies of the identified articles and from recommendations of expert consultants. When little or no data exist from well-designed prospective trials, emphasis is given to results from large series and reports from recognized experts. Guidelines for appropriate utilization of endoscopy are based on a critical review of the available data and expert consensus. Further controlled clinical studies are needed to clarify aspects of this statement, and revision may be necessary as new data appear. Clinical consideration may justify a course of action at variance to these recommendations.

Endoscopy, Gastrointestinal↗
PubMed2002

Role of endoscopy in enteral feeding.

This is one of a series of statements discussing the utilization of gastrointestinal endoscopy in common clinical situations. The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy prepared this text. A previous guideline related to this topic (ASGE Publication No. 1017, Gastrointest Endosc 1998;48:699-701). Since that time, new information has become available that requires an update of this statement and its recommendations. In preparing this update, a MEDLINE literature search was performed, and additional references were obtained from the bibliographies of the identified articles and from the recommendations of expert consultants. When inadequate data existed from well-designed prospective trials, emphasis was given to results from large series and reports from recognized experts. Guidelines for appropriate utilization of endoscopy are based on a critical review of the available data and expert consensus. Controlled clinical studies are needed to clarify aspects of this statement, and revision may be necessary as new data appear. Clinical consideration may justify a course of action at variance from these recommendations.

Endoscopy, Gastrointestinal↗
PubMed2002

Guideline for the management of ingested foreign bodies.

This is one of a series of statements discussing the utilization of gastrointestinal endoscopy in common clinical situations. The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy prepared this text. In preparing this guideline, a MEDLINE literature search was performed, and additional references were obtained from the bibliographies of the identified articles and from recommendations of expert consultants. When little or no data exist from well-designed prospective trials, emphasis is given to results from large series and reports from recognized experts. Guidelines for appropriate utilization of endoscopy are based on a critical review of the available data and expert consensus. Further controlled clinical studies are needed to clarify aspects of this statement, and revision may be necessary as new data appear. Clinical consideration may justify a course of action at variance to these recommendations.

Digestive System↗
PubMed2002

Endoscopic palliation of colorectal cancer.

Multiple endoscopic options exist for physicians seeking to provide palliative therapy for patients with colorectal cancer. Endoscopic decompression tubes can allow urgent stabilization for patients with malignant obstruction requiring some form of surgical palliation. Patients who are not candidates for palliative surgery can experience good symptomatic relief from malignant large bowel obstruction via laser therapy or placement of a colonic stent. Laser therapy can be used in conjunction with SEMS to recanalize and decompress large bowel in certain situations. The use of colonic stents is rapidly becoming more commonplace as acceptance of the technique becomes more widespread. Patients with unresectable disease may be able to avoid surgery altogether and achieve successful and lasting palliation of large bowel obstruction. Overall, they provide effective and durable palliation in patients with malignant obstruction, have an excellent risk/benefit profile, and are within the technical means of both gastroenterologists and interventional radiologists.

Colonic Neoplasms↗
PubMed2002

Percutaneous transgastric placement of jejunal feeding tubes with an ultrathin endoscope.

BACKGROUND: Placement of jejunal feeding tubes in patients with PEG tubes by conventional techniques is often difficult. This is a description of a simple method for placement of jejunal tubes by using an ultrathin endoscope. This method does not always require conscious sedation. METHODS: An ultrathin endoscope is passed through a mature gastrostomy tract to the proximal jejunum. A guidewire passed through the endoscope and placed beyond the ligament of Treitz is then used under fluoroscopy to place a transgastric jejunal feeding tube. OBSERVATIONS: Sixteen jejunal feeding tube placements were performed in 13 patients over a period of 20 months. Six patients required conscious sedation. Jejunal tubes had feeding channels of 10 to 12F. There were no complications. Feedings began on the day of placement. CONCLUSIONS: Ultrathin endoscopes can be used to place jejunal feeding tubes by means of the transgastric route. The procedure is simple, quick, and safe. In some patients, the use of conscious sedation can be avoided.

Adult↗
PubMed2002

2-Octyl-cyanoacrylate (Dermabond), a new glue for variceal injection therapy: results of a preliminary animal study.

BACKGROUND: Endotherapy of bleeding gastric varices is problematic. The aim of this descriptive study in an animal model was to compare 2-octyl-cyanoacrylate (Dermabond), a Food and Drug Administration-approved agent for superficial wound closure, to N-butyl-2-cyanoacrylate (Histoacryl), an agent available outside of the United States for the endoscopic treatment of bleeding gastric varices. METHODS: Eight New Zealand white rabbits were randomly assigned to either the study agent Dermabond or the control agent, Histoacryl. Both active agents were equally mixed with ethiodized poppy seed oil (Ethiodol) and injected into the auricular vein. The animals were euthanized at various time intervals after injection. A 2 cm strip of tissue on either side of the injection site along with the adjacent perivascular tissues were resected for histologic evaluation. RESULTS: The use of 0.5 mL of Dermabond effectively induced vascular occlusion compared with 0.2 mL of Histoacryl. The histologic changes acutely and at 1 week were similar with each mixture. CONCLUSION: Dermabond may be useful in the treatment of gastric variceal bleeding, but further studies are necessary to determine dose response rates in animals and humans.

Animals↗
PubMed2002

Outcome differences after endoscopic drainage of pancreatic necrosis, acute pancreatic pseudocysts, and chronic pancreatic pseudocysts.

BACKGROUND: Comparative outcomes after endoscopic drainage of specific types of symptomatic pancreatic fluid collections, defined by using standardized nomenclature, have not been described. This study sought to determine outcome differences after attempted endoscopic drainage of pancreatic fluid collections classified as pancreatic necrosis, acute pseudocyst, and chronic pseudocyst. METHODS: Outcomes were retrospectively analyzed for consecutive patients with symptoms caused by pancreatic fluid collections referred for endoscopic transmural and/or transpapillary drainage. RESULTS: Complete endoscopic resolution was achieved in 113 of 138 patients (82%). Resolution was significantly more frequent in patients with chronic pseudocysts (59/64, 92%) than acute pseudocysts (23/31, 74%, p = 0.02) or necrosis (31/43, 72%, p = 0.006). Complications were more common in patients with necrosis (16/43, 37%) than chronic (11/64, 17%, p = 0.02) or acute pseudocysts (6/31, 19%, p = NS). At a median follow-up of 2.1 years after successful endoscopic treatment (resolution), pancreatic fluid collections had recurred in 18 of 113 patients (16%). Recurrences developed more commonly in patients with necrosis (9/31, 29%) than acute pseudocysts (2/23, 9%, p = 0.07) or chronic pseudocysts (7/59, 12%, p = 0.047). CONCLUSIONS: Successful resolution of pancreatic fluid collections may be achieved endoscopically by an experienced therapeutic endoscopist. Outcomes differ depending on the type of pancreatic fluid collection drained. Further studies of endoscopic drainage of pancreatic fluid collections must use defined terminology to allow meaningful comparisons.

Acute Disease↗